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Background Early detection of mobility decline is critical to prevent subsequent reductions in quality of life, disability, and mortality. However, traditional approaches to mobility assessment are limited in their ability to capture daily fluctuations that align with sporadic health events. We aim to describe findings from a pilot study of our Real-time Online Assessment and Mobility Monitor (ROAMM) smartwatch application, which uniquely captures multiple streams of data in real time in ecological settings. Methods Data come from a sample of 31 participants (Mage = 74.7, 51.6% female) who used ROAMM for approximately 2 weeks. We describe the usability and feasibility of ROAMM, summarize prompt data using descriptive metrics, and compare prompt data with traditional survey-based questionnaires or other established measures. Results Participants were satisfied with ROAMM’s function (87.1%) and ranked the usability as “above average.” Most were highly engaged (average adjusted compliance = 70.7%) and the majority reported being “likely” to enroll in a 2-year study (77.4%). Some smartwatch features were correlated with their respective traditional measurements (eg, certain GPS-derived life-space mobility features (r = 0.50–0.51, p < .05) and ecologically measured pain (r = 0.72, p = .01), but others were not (eg, ecologically measured fatigue). Conclusions ROAMM was usable, acceptable, and effective at measuring mobility and risk factors for mobility decline in our pilot sample. Additional work with a larger and more diverse sample is necessary to confirm associations between smartwatch-measured features and traditional measures. By monitoring multiple data streams simultaneously in ecological settings, this technology could uniquely contribute to the evolution of mobility measurement and risk factors for mobility loss.

Aging is associated with declines in walking function. To understand these mobility declines, many studies have obtained measurements while participants walk on flat surfaces in laboratory settings during concurrent cognitive task performance (dual-tasking). This may not adequately capture the real-world challenges of walking at home and around the community. Here, we hypothesized that uneven terrains in the walking path impose differential changes to walking speed compared to dual-task walking. We also hypothesized that changes in walking speed resulting from uneven terrains will be better predicted by sensorimotor function than cognitive function. Sixty-three community-dwelling older adults (65-93 yrs old) performed overground walking under varying walking conditions. Older adults were classified into two mobility function groups based on scores of the Short Physical Performance Battery. They performed uneven terrain walking across four surface conditions (Flat, Low, Medium, and High unevenness) and performed single and verbal dual-task walking on flat ground. Participants also underwent a battery of cognitive (cognitive flexibility, working memory, inhibition) and sensorimotor testing (grip strength, 2-pt discrimination, pressure pain threshold). Our results showed that walking speed decreased during both dual-task walking and across uneven terrain walking conditions compared to walking on flat terrain. Participants with lower mobility function had even greater decreases in uneven terrain walking speeds. The change in uneven terrain speed was associated with attention and inhibitory function. Changes in both dual-task and uneven terrain walking speeds were associated with 2-point tactile discrimination. This study further documents associations between mobility, executive functions, and somatosensation, highlights the differential costs to walking imposed by uneven terrains, and identifies that older adults with lower mobility function are more likely to experience these changes to walking function.

Poor sleep health is an understudied yet potentially modifiable risk factor for reduced life space mobility (LSM), defined as one's habitual movement throughout a community. The objective of this study was to determine whether recalled changes in sleep traits (e.g., sleep quality, refreshing sleep, sleep problems, and difficulty falling asleep) because of the COVID-19 pandemic were associated with LSM in older adults.Data were obtained from a University of Florida-administered study conducted in May and June of 2020 (n = 923). Linear regression models were used to assess the impact of COVID-related change in sleep traits with summary scores from the Life Space Assessment. Analyses were adjusted for demographic, mental, and physical health characteristics, COVID-related avoidant behaviors, and pre-COVID sleep ratings.In unadjusted models, reporting that any sleep trait got "a lot worse" or "a little worse" was associated with a decrease in LSM (all p 0.05). Results were attenuated when accounting for demographic, mental, and physical health characteristics. In fully adjusted models, reporting that problems with sleep got "a lot worse" or that refreshing sleep got "a little worse" was associated with a lower standardized LSM score (β = -0.38, 95% CI: -0.74, -0.01, and β = -0.19, 95% CI: -0.37, -0.00, respectively).While additional research is needed in diverse people and environments, the results demonstrate an association between sleep traits that worsen in response to a health threat and reduced LSM. This finding suggests that interventions that focus on maintaining sleep health in times of heightened stress could preserve LSM.

Purpose: The importance of body composition on cancer outcomes is of great clinical interest. Measures of body composition that differentiate fat mass from skeletal muscle mass can help redefine our understanding of body composition for cancer survival. We investigated whether the risk of all-cause and cancer-specific mortality differ by levels of total fat mass and sarcopenia status in cancer survivors. Our secondary aim was a subgroup analysis assessing the role of race within these associations. Methods: Participants included 1682 adult cancer survivors who had undergone a dual-energy X-ray absorptiometry (DXA) examination to measure body composition, from the 1999–2006 and 2011–2018 National Health and Nutrition Examination Survey (NHANES). Total fat mass was categorized into tertiles (we assessed high vs. low tertiles), and sarcopenia was considered as having an appendicular skeletal muscle mass index less than 7.26 kg/m2 for males and less than 5.45 kg/m2 for females. Multivariable Cox proportional hazard models estimated the adjusted hazard ratio (aHR) and 95% confidence interval (CI). Results: The mean age of study participants was 61.9 years, and they were followed up for an average of 9.67 years. The prevalence of sarcopenia was 25.0% (N = 304), and 33.4% (N = 561) had a high total fat mass. Participants with a higher fat mass (aHR = 1.30, 95% CI = 1.06–1.61) and with sarcopenia (aHR = 1.51, 95% CI = 1.22–1.88) had a 30% and 51% increased risk of all-cause mortality compared to participants with a low fat mass and with no sarcopenia, respectively. Further, sarcopenia (aHR = 1.74, 95% CI = 1.23–2.29) was associated with a higher risk of cancer-specific mortality in cancer survivors. The association between sarcopenia and all-cause mortality was twice as strong in Black people (aHR = 2.99, 95% CI = 1.39–6.06) compared to White people (aHR = 1.53, 95% CI = 1.19–1.95). Conclusions: Our findings show the opposing relations of fat mass and appendicular skeletal muscle mass index with mortality in a national sample of cancer survivors, and that the relationships may differ by race. These results emphasize the importance of maintaining a healthy body composition among cancer survivors.

BACKGROUND During the COVID-19 pandemic, media sources dedicated significant time and resources to improve knowledge of COVID-19 precautionary behaviors (eg, wearing a mask). Many older adults report using the television, radio, print newspapers, or web-based sources to get information on political news, yet little is known about whether consuming news in the early phase of the pandemic led to behavior change, particularly in older adults. OBJECTIVE The goals of this study were to determine (1) whether dosage of news consumption on the COVID-19 pandemic was associated with COVID-19 precautionary behaviors; (2) whether being an ever-user of social media was associated with engagement in COVID-19 precautionary behaviors; and (3) among social media users, whether change in social media use during the early stages of the pandemic was associated with engagement in COVID-19 precautionary behaviors. METHODS Data were obtained from a University of Florida–administered study conducted in May and June of 2020. Linear regression models were used to assess the association between traditional news and social media use on COVID-19 precautionary behaviors (eg, mask wearing, hand washing, and social distancing behaviors). Analyses were adjusted for demographic characteristics, including age, sex, marital status, and education level. RESULTS In a sample of 1082 older adults (mean age 73, IQR 68-78 years; 615/1082, 56.8% female), reporting 0 and 3 hours per day, was associated with lower engagement in COVID-19 precautionary behaviors in models adjusted for demographic characteristics (β=–2.00; PP=.01, respectively). In addition, increasing social media use (relative to unchanged use) was associated with engagement in more COVID-19 precautionary behaviors (β=.70, P CONCLUSIONS The results demonstrated an association between higher media consumption and greater engagement in COVID-19 precautionary behaviors in older adults. These findings suggest that media can be effectively used as a public health tool for communication of prevention strategies and best practices during future health threats, even among populations who are historically less engaged in certain types of media.

Accuracy of electroencephalography (EEG) source localization relies on the volume conduction head model. A previous analysis of young adults has shown that simplified head models have larger source localization errors when compared with head models based on magnetic resonance images (MRIs). As obtaining individual MRIs may not always be feasible, researchers often use generic head models based on template MRIs. It is unclear how much error would be introduced using template MRI head models in older adults that likely have differences in brain structure compared to young adults. The primary goal of this study was to determine the error caused by using simplified head models without individual-specific MRIs in both younger and older adults. We collected high-density EEG during uneven terrain walking and motor imagery for 15 younger (22±3 years) and 21 older adults (74±5 years) and obtained T1-weighted MRI for each individual. We performed equivalent dipole fitting after independent component analysis to obtain brain source locations using four forward modeling pipelines with increasing complexity. These pipelines included: 1) a generic head model with template electrode positions or 2) digitized electrode positions, 3) individual-specific head models with digitized electrode positions using simplified tissue segmentation, or 4) anatomically accurate segmentation. We found that when compared to the anatomically accurate individual-specific head models, performing dipole fitting with generic head models led to similar source localization discrepancies (up to 2 cm) for younger and older adults. Co-registering digitized electrode locations to the generic head models reduced source localization discrepancies by ~6 mm. Additionally, we found that source depths generally increased with skull conductivity for the representative young adult but not as much for the older adult. Our results can help inform a more accurate interpretation of brain areas in EEG studies when individual MRIs are unavailable.

BACKGROUND African American (AA) older adults with knee osteoarthritis experience more severe chronic pain and advanced physical disability. One of the most prominent stimuli that provokes knee pain is movement. Research suggests that, compared to Whites, AAs report significantly higher movement-evoked pain (MEP) in the knee. However, little is known about the biopsychosocial-behavioral mechanisms underlying MEP. OBJECTIVES The aim of the study was to present a study protocol to (a) characterize the biopsychosocial-behavioral mechanisms that predict MEP in AAs with knee osteoarthritis and (b) develop a targeted, mechanism-based self-management intervention to reduce MEP and maximize movement. METHODS An observational, mixed-methods cohort study will enroll 90 AA/Black adults (ages 55-90 years) to understand intraindividual and interindividual effects on MEP. Participants will complete assessments of MEP, function and gait, biopsychosocial-behavioral questionnaires, quantitative sensory testing, and 7-day ecological momentary assessments of pain and related symptoms. For the qualitative phase, focus groups will be conducted to co-construct a mechanism-based pain self-management intervention. RESULTS We will develop phenotypes of MEP based on biopsychosocial-behavioral predictors and correlate measures of MEP with function. Our central hypothesis is that higher levels of MEP will predict lower self-reported function and poorer performance on functional tasks and that multiple biopsychosocial and behavioral factors will be associated with MEP and function. Predictors may serve as risk or protective factors for MEP and physical function. In targeting the biopsychosocial-behavioral mechanisms of MEP, we anticipate that older AAs may request that intervention components include culturally tailored self-management education, movement/physical activity training, treatment decision-making skills, coaching, spirituality, and social/kinship support. CONCLUSION Osteoarthritis is now the single most common cause of disability, mobility limitations, and persistent pain in older adults-especially AA older adults. To our knowledge, this will be the first study to systematically phenotype MEP in an older racial minority population with knee osteoarthritis and will be relevant for reducing knee pain and improving function.

Dihydropyridine calcium channel blockers (DH CCBs) are commonly used for hypertension in older adults. However, loop diuretics can be inappropriately added to treat DH CCB-induced edema, putting individuals at increased risk for adverse events and potential decreases in quality of life. We conducted a cross-sectional analysis using United States Medical Expenditure Panel Survey (MEPS) data from 2003 to 2015. Adults aged ≥ 55 years without congestive heart failure, nephrotic syndrome, chronic kidney disease, renal failure, and cirrhosis who had consecutive rounds of DH CCB use (round 1 and 2 or round 3 and 4) and completed the self-administered questionnaire (SAQ) were included. Patients initiated on loop diuretics in round 2 or 4 were compared to those not initiated. Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were analyzed using multivariable linear regression models. Among 5,458,467 DH CCB users (weighted), 3.4% of individuals were identified with new loop diuretic use (185,130 weighted). After adjusting for covariates, DH CCB plus loop diuretic use was associated with a PCS score 3.12 units lower (95% confidence interval − 5.40 to − 0.83; p = 0.008) than DH CCB use alone. We observed no significant difference in MCS score (p = 0.160) among DH CCB plus loop diuretic users compared to DH CCB users alone. New loop diuretic use was associated with lower physical functioning among DH CCB users. These findings suggest that this potential prescribing cascade may result in both significant and clinically meaningful decreases in health-related quality of life. It is important for clinicians to avoid or intervene on this inappropriate prescribing cascade when possible.

Interleukin (IL)-6 is a well-accepted biomarker of chronic low-grade inflammation possibly conditioning the effect of physical activity (PA) intervention on physical performance in mobility-limited older adults. We evaluated PA intervention effects on 400 m gait speed by yearly change of IL-6 levels in a post-hoc analysis from Lifestyle Interventions and Independence for Elders (LIFE) Study, a multicenter single-blind randomized clinical trial on 1300 sedentary older adults (mean age:78.85 ± 5.23,65.85 % women) at risk for mobility disability. We compared the intervention effects on 400 m gait speed at 12 months follow-up, according to yearly IL-6 change categorized for 1 pg/ml increase or decrease, and subsequently for larger range of yearly variation. Among subjects with yearly IL-6 change between -1 and + 2 pg/ml, we observed a significant difference of gait speed in PA intervention group compared to healthy educational intervention group [0.041 m/s,95 % confidence interval (CI):0.008-0.074,p = 0.006;Cohen's d:0.26, 95 % CI:0.12-0.41). No effects were observed on 400 m gait speed for wider range of variation of plasma IL-6 levels. Limiting change of IL-6 levels under this specific hormetic window could be an important goal to achieve better benefit from PA intervention in terms of gait speed change and prevention of mobility disability.

Epidemiologic evidence reporting the role of frailty in survival among older adults with a prior cancer diagnosis is limited.A total of 2050 older adults (≥60 years old) surviving for at least 1 year after a cancer diagnosis and 9474 older adults without a cancer history from the National Health and Nutrition Examination Survey (1999-2014) were included for analysis. The exposure variable, a 45-item frailty index (FI), was categorized on the basis of validated cutoffs (FI ≤ 0.10 [fit], 0.10FI ≤ 0.21 [prefrail], and FI0.21 [frail]). All-cause mortality was ascertained via the National Death Index. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence interval (CIs) for the FI, and this was followed by restricted cubic splines depicting dose-response curves.For older cancer survivors, the mean age at the baseline was 72.6 years (SD, 7.1 years); 5.9% were fit, 38.2% were prefrail, and 55.9% were frail. Older adults without a cancer history were slightly younger (mean age, 70.0 years) and less frail (47.9% were frail). At each level of the FI, cancer survivors (1.9 per 100 person-years for FI ≤ 0.10, 3.4 per 100 person-years for 0.10FI ≤ 0.21, and 7.5 per 100 person-years for FI0.21) had higher mortality than their cancer-free counterparts (1.4 per 100 person-years for FI ≤ 0.10, 2.4 per 100 person-years for 0.10FI ≤ 0.21, and 5.4 per 100 person-years for FI0.21). The multivariable model suggested a positive association between the FI and all-cause mortality for survivors (aHR for FI0.21 vs FI ≤ 0.10, 2.80; 95% CI, 1.73-4.53) and participants without a cancer history (aHR for FI0.21 vs FI ≤ 0.10, 2.75; 95% CI, 2.29-3.32). Restricted cubic splines indicated that all-cause mortality risk increased with the FI in a monotonic pattern.Frailty is associated with a higher risk of death in older cancer survivors and the elderly without a cancer history.

OBJECTIVES: To compare a composite measure of physical function that comprises locomotor and non-locomotor tests (i.e., the Mobility Battery Assessment (MBA)) with traditional measures of mobility (4-m usual gait speed (UGS), six-minute walk (6MW) gait speed, and short physical performance battery (SPPB) score) for assessing lower extremity function and discriminating community dwelling older adults with and without mobility limitations. DESIGN: Cross-sectional, observational study. SETTING: Laboratory-based. PARTICIPANTS: 89 community-dwelling older adults (74.9±6.7). MEASUREMENTS: Using principal component analysis we derived an MBA score for 89 community-dwelling older adults, and quantified 4-m UGS, 6MW gait speed, and SPPB score. The MBA score was based on five lab-based tests. We also quantified self-reported lower extremity function/mobility using the Neuro-QOL Lower Extremity Function-Mobility instrument. Based on this data a continuous score was derived and subjects were classified as “mobility limited” or “non-mobility limited”. Correlations between the mobility measures and the Neuro-QOL score were calculated, and ROC curves were constructed to determine the AUC for the mobility measures ability to predict mobility limitations. RESULTS: The MBA had the largest AUC (0.92) for discriminating mobility limitations and exhibited the strongest correlation (0.73) with the Neuro-QOL Lower Extremity Function-Mobility Scale. The worst performing predictors were the 4-meter UGS and stair climb power both with an AUC of 0.8 for discriminating mobility limitations, and a low correlation with Neuro-QOL Lower Extremity Function Scale of 0.39 and 0.46, respectively. CONCLUSION: The MBA score moderately improves the magnitude of correlation and discrimination of mobility limitation in older adults than singular, standard tests of mobility.

BACKGROUND/OBJECTIVES: The extent to which the prevalence of muscle weakness in the US population varies by different putative grip strength constructs developed by the Sarcopenia Definitions and Outcomes Consortium (SDOC) has not been described. DESIGN: Cross-sectional analysis. SETTING: Two nationally representative cohorts-2010 and 2012 waves of the Health and Retirement Survey and round 1 (2011) of the National Health and Aging Trends Survey. PARTICIPANTS: Adults aged 65 years and older (n = 12,984) were included in these analyses. MEASUREMENTS: We analyzed three constructs of muscle weakness developed by the SDOC, and found to be associated with mobility disability for men and women, respectively: absolute grip strength (

BACKGROUND The Sarcopenia Definitions and Outcomes Consortium (SDOC) is a collaborative initiative seeking to develop and evaluate cut-points for low muscle strength and lean mass that predict an increased risk for slowness (usual walking speed

Background Approximately 35% of individuals > 70 years have mobility limitations. Historically, it was posited lean mass and muscle strength were major contributors to mobility limitations, but recent findings indicate lean mass and muscle strength only moderately explain mobility limitations. One likely reason is that lean mass and muscle strength do not necessarily incorporate measures globally reflective of motor function (defined as the ability to learn, or to demonstrate, the skillful and efficient assumption, maintenance, modification, and control of voluntary postures and movement patterns). In this study we determined the relative contribution of lean mass, muscle strength, and the four square step test, as an index of lower extremity motor function, in explaining between-participant variance in mobility tasks. Methods In community-dwelling older adults (N = 89; 67% women; mean 74.9 ± 6.7 years), we quantified grip and leg extension strength, total and regional lean mass, and time to complete the four square step test. Mobility was assessed via 6-min walk gait speed, stair climb power, 5x-chair rise time, and time to complete a complex functional task. Multifactorial linear regression modeling was used to determine the relative contribution (via semi-partial r2) for indices of lean mass, indices of muscle strength, and the four square step test. Results When aggregated by sex, the four square step test explained 17–34% of the variance for all mobility tasks (p p Conclusion The four square step test is uniquely associated with multiple measures of mobility in older adults, suggesting lower extremity motor function is an important factor for mobility performance. Trial registration NCT02505529–2015/07/22.

Objectives To develop an evidence-based definition of sarcopenia that can facilitate identification of older adults at risk for clinically relevant outcomes (eg, self-reported mobility limitation, falls, fractures, and mortality), the Sarcopenia Definition and Outcomes Consortium (SDOC) crafted a set of position statements informed by a literature review and SDOC's analyses of eight epidemiologic studies, six randomized clinical trials, four cohort studies of special populations, and two nationally representative population-based studies. Methods Thirteen position statements related to the putative components of a sarcopenia definition, informed by the SDOC analyses and literature synthesis, were reviewed by an independent international expert panel (panel) iteratively and voted on by the panel during the Sarcopenia Position Statement Conference. Four position statements related to grip strength, three to lean mass derived from dual-energy x-ray absorptiometry (DXA), and four to gait speed; two were summary statements. Results The SDOC analyses identified grip strength, either absolute or scaled to measures of body size, as an important discriminator of slowness. Both low grip strength and low usual gait speed independently predicted falls, self-reported mobility limitation, hip fractures, and mortality in community-dwelling older adults. Lean mass measured by DXA was not associated with incident adverse health-related outcomes in community-dwelling older adults with or without adjustment for body size. Conclusion The panel agreed that both weakness defined by low grip strength and slowness defined by low usual gait speed should be included in the definition of sarcopenia. These position statements offer a rational basis for an evidence-based definition of sarcopenia. The analyses that informed these position statements are summarized in this article and discussed in accompanying articles in this issue of the journal. J Am Geriatr Soc 68:1410-1418, 2020.

Wearable devices, like smartwatches, are increasingly used for tracking physical activity, community mobility, and monitoring symptoms. Data generated from smartwatches (PGHD_SW) is a form of patient-generated health data, which can benefit providers by supplying frequent temporal information about patients. The goal of this study was to understand providers’ perceptions towards PGHD_SW adoption and its integration with electronic medical records. In-depth, semi-structured qualitative interviews were conducted with 12 providers from internal medicine, family medicine, geriatric medicine, nursing, surgery, rehabilitation, and anesthesiology. Diffusion of Innovations was used as a framework to develop questions and guide data analysis. The constant comparative method was utilized to formulate salient themes from the interviews. Four main themes emerged: (1) PGHD_SW is perceived as a relative advantage; (2) data are viewed as compatible with current practices; (3) barriers to overcome to effectively use PGHD_SW; (4) assessments from viewing sample data. Overall, PGHD_SW was valued because it enabled access to information about patients that were traditionally unattainable. It also can initiate discussions between patients and providers. Providers consider PGHD_SW important, but data preferences varied by specialty. The successful adoption of PGHD_SW will depend on tailoring data, frequencies of reports, and visualization preferences to correspond with the demands of providers.

Sufficient physical activity (PA) reduces the risk of a myriad of diseases and preserves physical capabilities in later life. While there have been significant achievements in mapping accelerations to real-life movements using machine learning (ML), errors continue to be common, particularly for wrist-worn devices. It remains unknown whether ML models are robust for estimating age-related loss of physical function. In this study, we evaluated the performance of ML models (XGBoost and LASSO) to estimate the hallmark measures of PA in low physical performance (LPP) and high physical performance (HPP) groups. Our models were built to recognize PA types and intensities, identify each individual activity, and estimate energy expenditure (EE) using wrist-worn accelerometer data (33 activities per participant) from a large sample of participants (n = 247, 57% females, aged 60+ years). Results indicated that the ML models were accurate in recognizing PA by type and intensity while also estimating EE accurately. However, the models built to recognize individual activities were less robust. Across all tasks, XGBoost outperformed LASSO. XGBoost obtained F1-Scores for sedentary (0.932 ± 0.005), locomotion (0.946 ± 0.003), lifestyle (0.927 ± 0.006), and strength flexibility exercise (0.915 ± 0.017) activity type recognition tasks. The F1-Scores for recognizing low, light, and moderate activity intensity were (0.932±0.005), (0.840 ± 0.004), and (0.869 ± 0.005), respectively. The root mean square error for EE estimation was 0.836 ± 0.059 METs. There was no evidence showing that splitting the participants into the LPP and HPP groups improved the models’ performance on estimating the hallmark measures of physical activities. In conclusion, using features derived from wrist-worn accelerometer data, machine learning models can accurately recognize PA types and intensities and estimate EE for older adults with high and low physical function.

Abstract: Sarcopenia, a condition characterized by the loss of muscle mass, strength and function with age, is highly prevalent in cancer survivors. The relationship between sarcopenia and prognosis among cancer survivors is not well understood. Methods: From the Third National Health and Nutrition Examination Survey (NHANES III), we identified 946 participants who were diagnosed with cancer (mean age 60.6 years); the most common disease sites were breast, prostate, colon and melanoma. We assembled an age, sex and race-matched cohort of 1,857 participants without cancer (mean age, 60.2 years). Sarcopenia was defined by appendicular lean mass and body height (men Citation Format: Dejana Braithwaite, Shama Karanth, Christiaan Leeuwenburgh, Todd M. Manini, Meghann Wheeler, Danting Yang, Livingstone Aduse-Poke, Stephen Anton, Frank Penedo, Erin M. Siegel, Jonathan D. Licht, Dongyu Zhang. Elevated all-cause and cardiovascular mortality in cancer survivors with sarcopenia [abstract]. In: Proceedings of the AACR Special Conference: Aging and Cancer; 2022 Nov 17-20; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_1):Abstract nr B001.

Objectives Our aim was to examine the impacts of baseline fatigue on the effectiveness of a physical activity (PA) intervention to prevent major mobility disability (MMD) and persistent major mobility disability (PMMD) in participants from the Lifestyle Interventions and Independence for Elders (LIFE) study. Design Prospective cohort of individuals aged 65 years or older undergoing structured PA intervention or health education (HE) for a mean of 2.6 years. Setting LIFE was a multicenter eight-site randomized trial that compared the efficacy of a structured PA intervention with an HE program in reducing the incidence of MMD. Participants Study participants (N = 1591) at baseline were 78.9 ± 5.2 years of age, with low PA and at risk for mobility impairment. Measurements Self-reported fatigue was assessed using the modified trait version of the Exercise-Induced Feelings Inventory, a six-question scale rating energy levels in the past week. Responses ranged from 0 (none of the time) to 5 (all of the time). Total score was calculated by averaging across questions; baseline fatigue was based on the median split: 2 or higher = more fatigue (N = 856) and lower than 2 = less fatigue (N = 735). Participants performed a usual-paced 400-m walk every 6 months. We defined incident MMD as the inability to walk 400-m at follow-up visits; PMMD was defined as two consecutive walk failures. Cox proportional hazard models quantified the risk of MMD and PMMD in PA vs HE stratified by baseline fatigue adjusted for covariates. Results Among those with higher baseline fatigue, PA participants had a 29% and 40% lower risk of MMD and PMMD, respectively, over the trial compared with HE (hazard ratio [HR] for MMD = .71; 95% confidence interval [CI] = .57-.90; P = .004) and PMMD (HR = .60; 95% CI = .44-.82; P = .001). For those with lower baseline fatigue, no group differences in MMD (P = .36) or PMMD (P = .82) were found. Results of baseline fatigue by intervention interaction was MMD (P = .18) and PMMD (P = .05). Conclusion A long-term moderate intensity PA intervention was particularly effective at preserving mobility in older adults with higher levels of baseline fatigue. J Am Geriatr Soc 68:619-624, 2020.

OBJECTIVES: To evaluate the prescription sequence symmetry analysis assumption regarding balance between marker drug (i.e., medication used to treat a drug-induced adverse event) initiation rates before and after initiation of an index drug (i.e., medication that is potentially associated with the drug-induced adverse event) in the absence of prescribing cascades, we used a well-described example of loop diuretic initiation to treat dihydropyridine calcium channel blockers (DH CCB)-induced edema. STUDY DESIGN AND SETTING: The University of Florida Health Integrated Data Repository from June 2011 and July 2018 was used to assess temporal prescribing of DH CCB and loop diuretics within the prescription sequence symmetry analysis framework. Validation of the prescribing cascade was performed via clinical expert chart review. RESULTS: Among patients without heart failure who were initiated on DH CCB, 26 and 64 loop diuretics initiators started within 360 days before versus after DH CCB initiation, respectively, resulting in an adjusted sequence ratio (aSR) of 2.27 (95% CI, 1.44–3.58). Overall, 35 (54.7%) patients were determined to have a prescribing cascade. Removing patients who experienced a prescribing cascade resulted in an aSR of 1.05, 95% CI 0.62–1.78). CONCLUSION: Loop diuretic initiation rates before and after DH CCB initiation for reasons other a prescribing cascade were similar, thus confirming the prescription sequence symmetry analysis assumption.

Background Cut-points to define slow walking speed have largely been derived from expert opinion. Methods Study participants (13 589 men and 5043 women aged ≥65years) had walking speed (m/s) measured over 4–6 m (mean ± SD: 1.20 ± 0.27 m/s in men and 0.94 ± 0.24 m/s in women.) Mobility limitation was defined as any self-reported difficulty with walking approximately 1/4 mile (prevalence: 12.6% men, 26.4% women). Sex-stratified classification and regression tree (CART) models with 10-fold cross-validation identified walking speed cut-points that optimally discriminated those who reported mobility limitation from those who did not. Results Among 5043 women, CART analysis identified 2 cut-points, classifying 4144 (82.2%) with walking speed ≥0.75 m/s, which we labeled as “fast”; 478 (9.5%) as “intermediate” (walking speed ≥0.62 m/s but Conclusions Cut-points in walking speed of approximately 0.60 m/s and 0.75 m/s discriminate those with self-reported mobility limitation from those without.

Older citizens experience a large number of falls and hospitalizations per year throughout the world. These intervening health events (IHEs) such as falls/injuries, illnesses, hospitalizations, are strong precipitants of disability in older adults. They are episodic in nature, extremely difficult to study, and require continuous and long-term monitoring. Wearable technologies with remote capabilities are an ideal solution for capturing information before and after such events. This work presents the ROAMM campaign platform for harnessing sensor and interface capabilities on smart wearables to provide customizable, affordable, and versatile health monitoring that leads to practical remote-based interventions. The platform is flexible, efficient, and scalable for concurrently running multiple studies, each of which consists of patient-reported outcomes, ecological momentary assessments and mental health-related patient responses. Additionally, the system is able to capture and derive ecological, momentary assessments of pain with concurrent mobility tracking that allows life-space mobility ascertainment. The platform supports multiple watches, and we show implementations on both the Samsung Galaxy and Apple series of smartwatches.

The ability to adapt to environmental and task demands while walking is critical to independent mobility outside the home and this ability wanes with age. Such adaptability requires individuals to acutely change their walking speed. Regardless of age, changes between walking speeds are common in daily life, and are a frequent type of walking adaptability. Here, we report on older and younger adults when transitioning from preferred walking speed overground to either slower or faster walking. Specifically, we evaluated biomechanical parameters prior to, during, and post transition. Individuals approached the walking speed transition similarly, independent of whether the transition was to slower or faster walking. Regardless of age or walking speed, the step during which a walking speed transition occurred was distinct from those prior- and post- transition, with on average 0.15 m shorter step lengths, 3.6° more hip flexion, and 3.3° more dorsiflexion during stance. We also found that peak hip flexion occurred 22% later, and peak hip extension (39%), knee flexion (26%), and dorsiflexion (44%) occurred earlier in stance for both typical to slower and typical to faster walking. Older adults had altered timing of peak joint angles compared with younger adults across both acceleration and deceleration conditions, indicating age-dependent responses to changing walking speed. Our findings are an important first step in establishing values for kinematics during walking speed transitions in younger and typical older adults.

OBJECTIVES Decline in physical function is associated with older age. Healthcare utilization and expenditures related to physical functioning declines will likely increase as the proportion of the population of older adults rises. This study evaluated resource utilization associated with differences in physical functioning in a nationally representative sample of older adults. DESIGN A retrospective panel study nationally representative for 26 809 552 older adults in the United States. SETTING Medical Expenditure Panel Survey (MEPS) data from 2013 to 2014. PARTICIPANTS Adults aged 70 years or older who completed both rounds of the Self-Administered Questionnaire in MEPS. MEASUREMENTS Physical Component Score (PCS) from the Short-Form Health Survey as a measure of physical functioning was stratified into quartiles. Healthcare utilization (count of medical visits by setting) and total expenditures were assessed during and after the PCS measurements. Generalized linear mixed models, adjusted for demographic and clinical covariates, estimated the relationship between healthcare utilization and physical functioning. RESULTS The lowest functional status (Q1) was associated with significantly increased healthcare utilization of emergency department, inpatient, home health, outpatient, and total medical visits compared with the three higher quartiles groups (P

PURPOSE: To examine whether long-term fish oil (FO) supplementation is associated with a lower risk of mobility disability and enhances benefits of physical activity. METHODS: 1635 sedentary adults aged 70 to 89 years from the Lifestyle Interventions and Independence for Elders (LIFE) single-blinded randomized, multi-center clinical trial, which compared a structured physical activity (PA) program to a health education (HE) program. Primary outcome was incident major mobility disability (MMD), defined by loss of ability to walk 400m, measured every 6 months for an average of 2.6 years. Secondary outcomes included persistent mobility disability (PMD), Short Physical Performance Battery (SPPB), 400m walk speed, and grip strength. RESULTS: A third of participants reported using FO at baseline (456, 28%; mean age, 78.5 years; 70.5% women). MMD was experienced by 131 participants (28.7%) in the FO group and 405 (34.4%) participants in the nonuser group. After adjusting for confounders, FO supplementation was associated with a lower risk (hazard ratio [HR], 0.78; 95% CI, 0.64–0.96) of incident MMD. However, there was no interaction (P= .19) between FO supplementation and PA intervention for MMD. For the secondary outcome of PMD, the intervention association differed by supplementation (P= .002) with PA intervention associations of (HR, 1.36; 95% CI, 0.83–2.23) for users and (HR, 0.61; 95% CI, 0.46–0.81) for nonusers. Changes in physical performance outcomes were not modified by baseline FO supplementation or combination with PA. CONCLUSIONS: FO supplementation was associated with a lower risk of major mobility disability in low to moderate functioning older adults. However, supplementation did not enhance the benefit of physical activity on risk of mobility disability. These results are hypothesis generating and need to be confirmed in randomized trials.

Background Physical exercise is associated with decreased cardiovascular disease (CVD) risk, but recent large-scale trials suggest that exercise alone is insufficient to reduce CVD events in high-risk older adults. Purpose This pilot randomized clinical trial aimed to collect critical data on feasibility, safety, and protocol integrity necessary to design a fully powered randomized controlled trial (RCT) and evaluate the impact of combining structured exercise with an intervention designed to enhance non-exercise physical activity (EX+NEPA) compared to EX alone. Methods Forty participants aged ≥60 years with moderate-to-high risk of coronary heart disease events were randomly assigned to either the EX+NEPA or EX groups and followed for 20 weeks. Both groups underwent a twice-weekly, 8-week center-based exercise intervention with aerobic and resistance exercises. EX+NEPA group also received a wearable activity tracking device along with behavioral monitoring and feedback throughout the study. Study outcomes were evaluated at 8 and 20 weeks. Results Data are presented as adjusted mean change of the differences over time with 95% confidence intervals at 20 weeks. Relative to EX, the change in steps/day at 20 weeks was 1994 (-40.27, 4028) higher for EX+NEPA. For sedentary time at close-out, the EX+NEPA group was -6.8 (-45.2, 31.6) min/day relative to EX. The between-group differences for systolic and diastolic blood pressure were -9.9 (-19.6, -0.3) and -1.8 (-6.9, 3.3) mmHg, respectively. Conclusion The addition of wearable technology intervention appeared to positively influence daily activity patterns and changes in blood pressure - potentially improving risk factors for CVD. A fully powered randomized trial is needed to ultimately test this hypothesis.

OBJECTIVES Proton pump inhibitors (PPIs) and histamine2 receptor antagonists (H2 RAs) are associated with pharmacologic effects that may be detrimental to mobility and response to physical activity. Mobility disability and injurious fall outcomes in PPI and H2 RA users were compared with nonusers in this secondary analysis of data from the Lifestyle Interventions for Elders (LIFE) study. METHODS Participants ages 70-89 years were randomized to a physical activity (PA) or successful aging intervention and evaluated by medication use. Confounders included baseline demographic characteristics, physical function, cognitive function, sleep quality, and acid reflux symptoms that were adjusted via propensity score weighting. Outcomes were incident and persistent major mobility disability (MMD and pMMD) and injurious falls. Weighted proportional hazard models evaluated independent and interaction effects of PPIs and H2 RAs. RESULTS No interaction was found between PPIs and H2 RAs and the PA intervention. Drug use associations were significant for H2 RAs (hazard ratio [HR] 1.74 [95% confidence interval [CI] 1.12-2.68]) and PPIs (HR 1.32 [95% CI 1.02-1.70]) compared with nonusers for pMMD. PPIs were associated with increased injurious falls compared with nonusers (HR 1.44 [95% CI 1.06-1.96]). Pooling of data from the H2 RA and PPI exposure groups showed a 26% increase in MMD (HR 1.26 [95% CI 1.07-1.48]), a 44% increase in pMMD (HR 1.44 [95% CI 1.16-1.77]), and a 48% increase in injurious falls (HR 1.48 [95% CI 1.15-1.91]) compared with nonusers. All direct comparisons between PPIs and H2 RAs were nonsignificant. CONCLUSIONS Compared with nonusers, participants using either PPIs or H2 RAs had an increased risk of MMD, pMMD, and injurious falls. It is not known if these effects are related to the individual pharmacology of each medication, reduced acid secretion, or the underlying disease state. Further study is required to determine causality.

Transcutaneous electrical stimulation (TES) is a frequently used adjunctive modality in dysphagia rehabilitation. Stimulating deeper swallowing muscles requires higher TES amplitude. However, TES amplitude is limited by maximum amplitude tolerance (MAT). Previous studies have reported high interindividual variability regarding MAT and perceived discomfort. This variability might be one of the potential reasons of conflicting outcomes in TES-based swallowing studies. MAT and perceived discomfort are influenced by a variety of biopsychological factors. The influence of these factors related to swallow applications is poorly understood. This study explored the relation of biopsychological factors with MAT and perceived discomfort related to TES in the submental area. A convenience sample of thirty community-dwelling older adults between 60 and 70 years of age provided data for this study. Gender, submental adipose tissue thickness, perceptual pain sensitivity, and pain-coping strategies were evaluated for each subject. Subsequently, MAT and perceived discomfort level were determined using TES on the submental area. Relation of different biopsychological variables with MAT and discomfort level was examined using Pearson and Spearman correlation, and Mann–Whitney U test. Results indicated that neither gender nor adipose thickness was related to MAT and perceived discomfort. Among studied pain-coping strategies, catastrophizing was significantly related to MAT(r = – 0.552, p

This study compared five different methods for analyzing accelerometer-measured physical activity (PA) in older adults and assessed the relationship between changes in PA and changes in physical function and depressive symptoms for each method. Older adult females (N=144, M(age)=83.3±6.4yrs) wore hip accelerometers for six days and completed measures of physical function and depressive symptoms at baseline and six months. Accelerometry data were processed by five methods to estimate PA: 1041 vertical axis cut-point, 15-second vector magnitude (VM) cut-point, 1-second VM algorithm (Activity Index (AI)), machine learned walking algorithm, and individualized cut-point derived from a 400-meter walk. Generalized estimating equations compared PA minutes across methods and showed significant differences between some methods but not others; methods estimated 6-month changes in PA ranging from 4 minutes to over 20 minutes. Linear mixed models for each method tested associations between changes in PA and health. All methods, except the individualized cut-point, had a significant relationship between change in PA and improved physical function and depressive symptoms. This study is among the first to compare accelerometry processing methods and their relationship to health. It is important to recognize the differences in PA estimates and relationship to health outcomes based on data processing method.

Background Lack of consensus on how to diagnose sarcopenia has limited the ability to diagnose this condition and hindered drug development. The Sarcopenia Definitions and Outcomes Consortium (SDOC) was formed to develop evidence-based diagnostic cut points for lean mass and/or muscle strength that identify people at increased risk of mobility disability. We describe here the proceedings of a meeting of SDOC and other experts to discuss strategic considerations in the development of evidence-based sarcopenia definition. Methods Presentations and panel discussions reviewed the usefulness of sarcopenia as a biomarker, the analytical approach used by SDOC to establish cut points, and preliminary findings, and provided strategic direction to develop an evidence-based definition of sarcopenia. Results The SDOC assembled data from eight epidemiological cohorts consisting of 18,831 participants, clinical populations from 10 randomized trials and observational studies, and 2 nationally representative cohorts. In preliminary assessments, grip strength or grip strength divided by body mass index was identified as discriminators of risk for mobility disability (walking speed Conclusions International consensus on an evidence-based definition of sarcopenia is needed. Grip strength—absolute or adjusted for body mass index—is an important discriminator of mobility disability and other endpoints. Additional research is needed to develop a predictive risk model that takes into account sarcopenia components as well as age, sex, race, and comorbidities.

Supplemental digital content is available in the text., Purpose The goal of this trial was to determine whether low-load blood flow–restricted (BFR) exercise of appendicular muscles induces a cross-transfer of effect to the trunk extensor (TE) muscles, such that low-load TE exercise would enhance TE size and function to a greater extent than standard low-load exercise in people with recurrent low back pain (LBP). We also investigated the direct effects of BFR exercise in the appendicular muscles. Methods Thirty-two adults with recurrent, nonspecific LBP were randomized into two groups: Appendicular BFR exercise (BFR exercise) or control exercise (CON exercise). All participants trained (two times per week) for 10 wk, with a 12-wk follow-up. Participants performed three sets of leg extension (LE), plantar flexion (PF), and elbow flexion (EF) exercises followed by low-load TE exercise without BFR. Outcome measures included magnetic resonance imaging–derived muscle size (quadriceps and TE), strength (LE, PF, EF, and TE), and endurance (LE and TE). Results There was no evidence for a cross-transfer of effect to the TE. There was also no statistically significant enhancement of limb skeletal muscle size or function of BFR relative to CON exercise at any time point; though, moderate effect sizes for BFR exercise were observed for enhanced muscle size and strength in the leg extensors. Conclusions Low-load BFR exercise of the appendicular muscles did not result in a cross-transfer of effect to the TE musculature. There was also no significant benefit of low-load BFR exercise on the appendicular muscle size and function, suggesting no benefit from low-load BFR exercise in adults with recurrent, nonspecific LBP.

Limited research in swallowing physiology has suggested that the most common existing transcutaneous electrical stimulation (TES) protocol (VitalStim) may not penetrate to layers of tissue to affect deep swallowing muscles. TES amplitude is the primary parameter that determines the depth of electrical current penetration (DECP). Preliminary work suggests that replacing a long-pulse duration with a short-pulse duration can increase maximum amplitude tolerance (MAT) within subjects' comfort level. Increasing MAT may indicate a higher DECP. The current study evaluates this premise in reference to the effects of varying pulse duration on lingual-palatal pressure during swallowing. Thirty healthy older adults (60-70 years of age) participated in this study. Each subject swallowed three trials of 10 mL pudding under three TES conditions: no stimulation, short-pulse duration, and long-pulse duration. TES was delivered using two pairs of surface electrodes on the submental muscles. MAT and perceived discomfort levels were identified separately for short and long-pulse TES conditions. Lingual-palatal peak pressure, pressure integral, and pressure duration were measured under each condition. Two-way repeated measures ANOVAs were conducted to identify within subject effects of TES condition and tongue bulb location. Lingual-palatal pressure and pressure integral were significantly reduced in the short-pulse duration condition. MAT was significantly higher in the short-pulse duration versus the long-pulse duration condition. Furthermore, MAT was significantly correlated with lingual-palatal pressure. Changing pulse duration had no significant impact on tongue pressure duration. Results suggest that a short-pulse duration may penetrate deeper into muscles involved in swallowing. The specific impact is reflected in a reduced upward pressure of the tongue on the palate during swallowing. This 'restrictive' effect of TES on tongue pressure may have the potential to be used during a resistive exercise paradigm for tongue elevation during swallowing.

Background The movement profile of older adults with compromised function is unknown, as is the relationship between these profiles and the development of major mobility disability (MMD)—a critical clinical outcome. We first describe the dimensions of movement in older adults with compromised function and then examine whether these dimensions predict the onset of MMD. Methods Older adults at risk for MMD (N = 1,022, mean age = 78.7 years) were randomized to receive a structured physical activity intervention or health education control. We assessed MMD in 6-month intervals (average follow-up of 2.2 years until incident MMD), with activity assessed at baseline, 6-, 12- and 24-month follow-up via accelerometry. Results A principal components analysis of 11 accelerometer-derived metrics yielded three components representing lifestyle movement (LM), extended bouts of moderate-to-vigorous physical activity (MVPA), and stationary body posture. LM accounted for the greatest proportion of variance in movement (53%). Within health education, both baseline LM (HR = 0.74; 95% CI 0.62 to 0.88) and moderate-to-vigorous physical activity (HR = 0.69; 95% CI 0.54 to 0.87) were associated with MMD, whereas only LM was associated with MMD within physical activity (HR = 0.74; 95% CI 0.61 to 0.89). There were similar nonlinear relationships present for LM in both physical activity and health education (p < .04), whereby risk for MMD was lower among individuals with higher levels of LM. Conclusions Both LM and moderate-to-vigorous physical activity should be central in treatment regimens for older adults at risk for MMD. Trial Registration clinicaltrials.gov Identifier NCT01072500